Hammertoe is the general term used to describe an abnormal contraction or "buckling" of the toe because of a partial or complete dislocation of one of the joints of the toe or the joint where the toe joins with the rest of the foot. Other types of crooked toes include claw toes and mallet toes. These are basically the same as hammer toes but involve bucking at different joints in the toe.
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ARE YOUR TOES HAMMERED?
Crooked toes themselves often do not cause pain, however as the toe becomes deformed, it rubs against the shoe and the irritation causes the body to build up more and thicker skin to help protect the area. The common name for the thicker skin is a corn. At first, this thick skin helps reduce irritation to the bone prominence, but as the skin becomes thicker, it adds to the pressure from the shoe. Periodic trimming of the corn may give temporary relief. However, over a period of time, a bursa may develop and if it becomes inflamed (bursitis), the area becomes red, swollen and painful. It may also become infected.
There are two joints in the lesser toes and one joint in the great toe. If the deformity occurs in the joint nearest the nail, it is called a mallet toe and the corn will usually develop on the tip of the toe. This is due to the pressure being on the tip of the last toe bone rather than at the fat pad under the tip of the toe. If the deformity is at the other toe joint, or where the toe joins the foot, it is called a hammertoe and the corn will occur on the top of the toe
Do not confuse corns with calluses that occur on the bottom of the feet. They are generally caused by other conditions, although a severe hammertoe may create downward pressure on a metatarsal bone at the ball of the foot, and add to the cause of a callus.
HOW DOES IT FEEL?
A hammertoe may be present but not always painful unless irritated by shoes. One may have enlarged toe joints with some thickened skin and no redness or swelling. However, if shoes create pressure on the joint, the pain will usually range from pinching and squeezing to sharp and burning. Cramping in the toes, foot and leg may develop from the muscles and tendons functioning in abnormal positions because of the deformed joints. In long standing conditions, the dislocated joints can cause the pain of arthritis.
HOW DID THIS HAPPEN?
Although there is little doubt shoes are responsible for causing corns, the size, shape and other characteristics of our feet are hereditary. The contraction and/or rotation of toes can be the result of poor mechanics of the foot, resulting in over‑pronation. This results in low or flat arches, which cause the muscles and tendons of the foot to twist the toes and joints away from their normal position. High arched feet (over‑supination) can also result in similar conditions.
A severe bunion may cause a hammertoe, as the great toe twists over or under the second toe, causing it to dislocate. Shoes cause the corn, as the bony top of the toe rubs on the toe box of the shoe, but the underlying problem is the abnormal position of the toe joints, which may be hereditary.
The crooked toe is irritated by the pressure on the joint or spur. As a result, the skin becomes thicker to form a protection. The thicker the skin, the more pressure and eventually, a bursitis under the corn may develop. This causes the joint to become red, swollen and painful. In addition, the skin can break down and become infected.
WHAT CAN I DO FOR IT?
The most important thing is to purchase well fitted, comfortable, low heeled shoes that do not irritate the crooked toe. Also, make sure your stockings are not tight, causing the toes to contract. High heel shoes should be worn at a minimum, as they cause the tendons of the toes to pull them up into a contracted position.
Tennis type and walking shoes have significantly decreased the complaint of many people with hammertoe deformities. Although the crooked toe is still present, it may not hurt if the shoe is large enough.
BATHROOM SURGERY ISN’T A GOOD IDEA!!
Trimming corns with a razor blade may give temporary relief, but is dangerous, as you can cut yourself and cause an infection. See your chiropodist for the right kind of treatment.
WHAT WILL MY CHIROPODIST DO FOR IT?
Your chiropodist will examine your feet and decide what type of hammertoe you have and rule out other medical conditions. Treatment may range from more appropriate footgear to periodic trimming and padding of the corn. Cortisone injections may be indicated if a bursitis is present. Antibiotics may be used in the presence of infection. Removable accommodative pads may be made for you.
A custom made orthotic may also be made for you to help minimize the effects of a flat foot or a high arched foot. Orthotics does not make the hammertoe or corns disappear, but may slow down or arrest the “buckling” process.
If conservative treatment is unsuccessful, surgical intervention may be suggested. In the early stages, when the toe joints are flexible, this may involve a minor procedure, such as cutting or lengthening the tendons to straighten the toe.
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